Facilitators and barriers to colorectal cancer screening in an outpatient setting

BACKGROUND Colorectal cancer(CRC)is the third most common cancer and the second leading cause of cancer-related deaths in the United States.Still,1 in 3 adults aged 50 years to 75 years have not been screened for CRC.Early detection and management of precancerous or malignant lesions has been shown to improve overall mortality.AIM To determine the most significant facilitators and barriers to CRC screening in an outpatient clinic in rural North Carolina.The results of this study can then be used for quality improvement to increase the rate of patients ages 50 to 75 who are up to date on CRC screening.METHODS This retrospective study examined 2428 patients aged 50 years to 75 years in an outpatient clinic.Patients were up to date on CRC screening if they had fecal occult blood test or fecal immunochemical test in the past one year,Cologuard in the past three years,flexible sigmoidoscopy/virtual colonoscopy in the past five years,or colonoscopy in the past ten years.Data on patient socioeconomic status,comorbid conditions,and other determinants of health compliance were included as covariates.RESULTS Age[odds ratio(OR)=1.058;P=0.017],no-show rate percent(OR=0.962;P<0.05),patient history of obstructive sleep apnea(OR=1.875;P=0.025),compliance with flu vaccinations(OR=1.673;P<0.05),compliance with screening mammograms(OR=2.130;P<0.05),and compliance with screening pap smears(OR=2.708;P<0.05)were important factors in determining whether a patient will receive CRC screening.Race,gender,insurance or employment status,use of blood thinners,family history of CRC,or other comorbid conditions including diabetes,hypertension,congestive heart failure,chronic obstructive pulmonary disease,and end-stage renal disease were not found to have a statistically significant effect on patient adherence to CRC screening.CONCLUSION Patient age,history of sleep apnea,and compliance with other health maintenance tests were significant facilitators to CRC screening,while no-show rate percent was a significant barrier in our patient population.This study will be of benefit to physicians in addressing and improving the CRC screening rates in our community.

Implications of COVID-19 for inflammatory bowel disease:Opportunities and challenges amidst the pandemic

Since the beginning of the coronavirus disease 2019(COVID-19)pandemic various measures have been taken to mitigate the effects of the global health crisis in this unprecedented time.According to the World Health Organization,more than 5 million people have been infected with severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)and with more than 300000 deaths attributed to COVID-19 worldwide.There is emerging evidence that SARS-CoV-2 utilizes angiotensin-converting enzyme 2 receptors to enter human cells which are found in abundance in the alveoli and intestines.In addition,the infection is noted to be more severe in patients with co-morbid conditions,those who are malnourished,immunosuppressed and immunocompromised.Inflammatory bowel disease(IBD)which includes ulcerative colitis and Crohn’s disease is chronic remitting and relapsing disorders with intestinal and extraintestinal manifestation.IBD patients are often malnourished and on immunosuppressive medications and there is a hypothetical concern that IBD patients are at substantial risk of COVID-19 infection.The management of IBD patients is often complex and poses unique challenges for gastroenterologists during the pandemic.The purpose of this review article is to summarize the growing level of evidence and understanding of the management of IBD during the COVID-19 pandemic,in the light of international and national gastroenterology society guidelines.We performed a thorough literature search on IBD,SARS-CoV-2 and COVID-19 on PubMed,EMBASE,OVID Medline and Google Scholar and pertaining literature was critically examined and summarized.Per national and international society guidelines and recommendations,IBD is not a risk factor for SARS-CoV-2 infection.IBD patients should continue with their medications and they should follow universal precautions i.e.masks,hand and respiratory hygiene and avoidance of health care facilities and public toilets as general population.Among IBD patients older age,having active disease,and co-morbid conditions are risk factors for a severe SARS-CoV-2 infection.Furthermore,elective endoscopic and surgical procedures can be delayed or deferred until discussing the risks and benefits with patients.